Arch Craniofac Surg.  2015 Aug;16(2):80-83. 10.7181/acfs.2015.16.2.80.

Reconstruction of Chronic Complicated Scalp and Dural Defects Using Acellular Human Dermis and Latissimus Dorsi Myocutaneous Free flap

• Lee JH
• Choi SK
• Kang SY

• KMID: 2167733
• DOI: http://doi.org/10.7181/acfs.2015.16.2.80

Abstract

We present reconstruction of a complicated scalp-dura defect using acellular human dermis and latissimus dorsi myocutaneous free flap. A 62-year-old female had previously undergone decompressive craniectomy for intracranial hemorrhage. The cranial bone flap was cryopreserved and restored to the original location subsequently, but necessitated removal for a methicillin-resistant Staphylococcal infection. However, the infectious nidus remained in a dermal substitute that was left over the cerebrum. Upon re-exploration, this material was removed, and frank pus was observed in the deep space just over the arachnoid layer. This was carefully irrigated, and the dural defect was closed with acellular dermal matrix in a watertight manner. The remaining scalp defect was covered using a free latissimus dorsi flap with anastomosis between the thoracodorsal and deep temporal arteries. The wound healed well without complications, and the scalp remained intact without any evidence of cerebrospinal fluid leak or continued infection.

Keyword

Dura mater; Acellular dermis; Free tissue flaps

MeSH Terms

Acellular Dermis
Arachnoid
Cerebrospinal Fluid
Cerebrum
Decompressive Craniectomy
Dermis*
Dura Mater
Female
Free Tissue Flaps*
Humans*
Intracranial Hemorrhages
Methicillin Resistance
Middle Aged
Scalp*
Staphylococcal Infections
Superficial Back Muscles*
Suppuration
Temporal Arteries
Wounds and Injuries